Research and Application Assignment: Intellectual Disability
Section A: Diagnostic Criteria
Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met:
- Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.
- Deficits in adaptive functioning that fail to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.
- Onset of intellectual and adaptive deficits during the developmental period.
Note: The diagnostic term intellectual disability is the equivalent term for the ICD-11 diagnosis of intellectual developmental disorders. Although the term intellectual disability is used throughout this manual, both terms are used in the title to clarify relationships with other classification systems. Moreover, a federal statute in the United States (Public Law 111-256, Rosa’s Law) replaces the term mental retardation with intellectual disability, and research journals use the term intellectual disability. Thus, intellectual disability is the term in common use by medical, educational, and other professions and by the lay public and advocacy groups.
Specify current severity (see Table):
- 317 (F70) Mild
- 318.0 (F71) Moderate
- 318.1 (F72) Severe
- 318.2 (F73) Profound
Section B: Discussion of Topic
Causes
Intellectual disability (ID) is a disorder that is associated with the below-average mental ability (Harris, 2006). People with this type of disorder do not have the necessary skills to perform normal daily activities such as communication, self-care and socialization. There are two main areas whose functioning is greatly affected by problems associated with intellectual disability. One of the areas is the intellectual functioning that involves tasks such as problem-solving, learning and judgment. The other one is known as adaptive functioning that involves activities such as communication and living independently and is most common in males with fragile X syndrome.
Intellectual disability may be classified as either mild, moderate, severe or profound. Individuals with mild intellectual disability are generally slower in performing social and daily skills which they can learn and be able to lead a normal life with minimum support. Individuals with moderate intellectual disability can perform basic skills and can comfortably take care of themselves. They require moderate support in taking care of themselves. Severe ID is characterized by major delays in normal development and individuals in this category can perform simple self-care activities but needs to be supervised in social settings. Individuals with profound ID require close supervision because they cannot perform daily self-care activities on their own and they cannot exercise independent living. They often suffer from congenital syndromes.
The cause of intellectual disability when brain development is interfered within which the interference may be due to a result of injury, illness or brain malformation. There are several main causes of intellectual disability. The causes are discussed below;
Physical causes such as injuries, diseases and other infections may lead to abnormal brain development (Harris, 2006). Diseases that may cause intellectual disability include meningitis and measles. Physical injuries that may cause head trauma are other physical factors that may expose an individual to intellectual disability. Other causes such as lack of proper medical care, life-threatening malnutrition and deficiency in nutrition during prenatal and postnatal care may affect fetal development and increase the risk of impairments in the developing infant. This leads to the development of mild intellectual disability (Harris, 2006).
Intellectual disability can also be caused by genetic conditions such as Fragile X syndrome and Down syndrome. This may be due to inheritance of abnormal genes or a bad combination of genes. Down syndrome is the most common and it occurs when an extra chromosome is formed when there is an error in the cell division process during the prenatal stage.
Fragile X syndrome is the other genetic cause of intellectual disability that is inherited and it involves the FRM1 gene that is located on the sex-determining X chromosome the reason why the syndrome is a leading cause of ID in males (Tabolacci & Neri, 2017). Boys have got only one X chromosome while girls have two X chromosomes. That is why boys tend to exhibit more severe and serious physical and behavioural problems because their only X chromosome is affected while girls will have inherited one affected X chromosome and the other one remains unaffected. Normally the FRM1 gene produces as multiple copies but with Fragile X, the multiplication is excess (Tabolacci & Neri, 2017). It is known as Fragile X because of the broken appearance of the X chromosome. The syndrome leads to behavioural traits of ID such as hyperactivity, poor coordination, poor social skills, and delays in speech and memory deficits and physical impairments such as elongated heads, large testicles after adolescence and large ears in boys whose X chromosome has been affected.
Environmental causes of intellectual disability include exposure to drugs and alcohol during pregnancy, prematurity and lack of oxygen during childbirth, exposure to poisonous toxins such as mercury and lead during prenatal and postnatal periods (Harris, 2006). The nervous system can be damaged during birth if the fetus doesn’t get enough oxygen a condition referred to as anoxia. It normally happens when fetus wraps itself with the umbilical cord around the neck thus reducing the amount of oxygen flowing. These complications cause an improper brain development process that eventually leads to mental and physical birth defects. Viral and bacterial infections during pregnancy can also expose the unborn fetus to behavioural and social problems. Exposure to high radiation in the uterus also exposes a developing fetus to intellectual disability.
Impacts
The impact of an individual’s intellectual disability varies depending on the cause of the ID. Individuals who suffer from intellectual disability face many challenges depending on the severity of the condition. Most individuals with intellectual disability have challenges in reading and writing and would therefore require specialized training for them to learn what normal individuals are learning easily. The level of support given to an individual depends on the severity of the disability and it can be determined after an assessment is done by a qualified medical practitioner. Limited support will be recommended for people with mild and moderate intellectual disability while extensive and pervasive support will be recommended for people who require close supervision. The best technique for teaching students with ID is to break down large tasks into manageable tasks and then teaching the students on a one-on-one setting. The use of assistive technology such as the use of actual tools has been employed to teach the individuals with ID. Individuals with an intellectual disability tend to have difficulties in communication and social skills where they do are not able to interact well with other people and they choose to remain lonely.
The other impact of the intellectual disability is on the family that has an individual with the ID where the family goes through a lot of stress in taking care of the affected individual. The family may undergo many challenges such as guilt, low self-esteem and poor physical and mental health. Important decisions may also be greatly affected as the family tries to adjust to the new lifestyle to accommodate the individual with ID. The maintenance of a person with ID is high considering the special care offered to the person such as the cost of medical care and learning is high compared to a normal person. On the other hand, the family with a member who has ID may increase their knowledge on the topic of intellectual developmental disorders and how to take care of people with similar conditions.
Another impact of intellectual disability is on society. The society doesn’t have proper mechanisms to take care of individuals with intellectual disability and most of the time they are stigmatized and discriminated because of lack of inclusivity in the society. The society should ensure that there is access to better healthcare and specialized education for people with ID. A society that doesn’t have better healthcare to cater for early diagnosis and treatment of individuals with intellectual disabilities end up in poverty with many cases of intellectual disabilities and other disorders.
Impact on learning is another important discussion because students with intellectual disability will require specialized help and support for them to make good progress in the same curriculum being followed by the students without disabilities. The students with ID should be helped to acquire skills on communication, basic mathematics, social skills and self-care skills. If need be, the learning environment for students with ID should be modified to accommodate them better. Such modifications may include the use of a special schedule, hands-on learning, and the special ratio of teacher to the student where one teacher serves a maximum of three students and performing functional activities.
Treatments
Intellectual disability is a condition that is life-long and can only be managed through interventions aimed at improving the functioning of an individual who has a disability. During gestation, mothers are advised to undergo serum screening which is a maternal blood test that is done to detect developmental disorders (Cuckle, Pergament, & Benn, 2015). Ultrasound can be used to detect physical abnormalities such as shorter nasal bones and a flat facial profile when the fetus is developing which indicates the possibility of a developmental disorder.
The kind of treatment for intellectual disability depends on the age of the individual as well as the impairment level (Harris, 2006). Immediately after birth, a series of blood tests are carried out on the newborns to detect the presence of metabolic and genetic disorders that are the main causes of intellectual disability. Infants who are found to be at risk of developing intellectual disability are normally assigned to an early intervention group in which parents are advised on how to promote cognitive and social development by practising some special activities and games with the infants. In the early intervention stage, families are shown how to develop a plan known as individualized Family Services Plan (IFSP). This plan helps to identify and address a child’s unique needs so that a family knows how to deal and assist a child with ID.
Counselling and family support should be provided to families that have children who are intellectually disabled (Coiffait & Leedham, 2016). The kind of struggle that a child with ID goes through makes the families go undergo a lot of stress and can lead to depression. Such families are encouraged to join support groups where they can meet other families who are in similar situations and they get a chance to share experiences and struggles that they go through. The families are also offered training programs where they are taught how to manage behaviours that are associated with intellectual disability.
Most treatment programs are aimed at reducing the challenging behaviours that are associated with intellectual disabilities. One of the approaches used is the applied behavior analysis (ABA) that is used to identify problematic behavior, determine the cause and develop ways on how to change it. Positive reinforcement is a technique used to reduce challenging behavior in a person with an ID. In differential reinforcement, a therapist will give positive reinforcement only for desirable behaviours and ignore the undesirable actions. Positive punishment is whereby a stimulus that decreases the frequency of a behavior is administered while negative punishment involves the withdrawal of a stimulus from a person with ID to prevent a certain problematic behavior from occurring. Positive punishment can only be administered if the parents have given consent. Psychological treatment for people with an intellectual disability involves conducting training on self-care skills, language and socialization aimed at improving their functioning.
Bonus section
Social service workers play a very important role in assisting clients who have an intellectual disability. Social workers must use their knowledge and skills in assisting people with ID by providing counselling and support programs and case management. They should also be in the frontline in advocating for the rights of people with ID. Social workers are always involved in organizing support programs to assist families that have children with intellectual disability and teach them the coping strategies on how to overcome stress. They should also be able to refer clients to professional therapists or agencies where they can get more help. Agencies that offer mental health services in Canada include Canadian Mental Health Association and the Centre for Addiction and Mental Health.
References
Coiffait, F. M., & Leedham, A. T. (2016). Psychological well-being of children and adults with severe and profound intellectual and developmental disabilities. Health Care for People with Intellectual and Developmental Disabilities across the Lifespan, 1401-1419. https://doi.org/10.1007/978-3-319-18096-0_113
Cuckle, H., Pergament, E., & Benn, P. (2015). Maternal serum screening for chromosomal abnormalities and neural tube defects. Genetic Disorders and the Fetus, 483-540. https://doi.org/10.1002/9781118981559.ch12
Harris, J. C. (2006). Intellectual disability: Understanding its development, causes, classification, evaluation, and treatment. Oxford University Press.
Tabolacci, E., & Neri, G. (2017). Epigenetic causes of intellectual disability—the fragile X syndrome paradigm. Neuropsychiatric Disorders and Epigenetics, 107-127. https://doi.org/10.1016/b978-0-12-800226-1.00006-x